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Overview

While vaccines remain the best strategy to prevent COVID-19, recent evidence suggests monoclonal antibodies (nMABs) or antivirals could potentially benefit certain vulnerable populations before or after exposure to SARS-CoV-2, such as the unvaccinated or recently vaccinated high-risk patients.

With the recent roll out of nMABs and antivirals, there is an urgent need to for knowledge and understanding around the use of nMABs and antivirals in the treatment of patients with COVID-19, such as factors of relevance in determining nMAB and antiviral treatment and the impact of nMAB and antiviral treatment in the community and hospital settings.

This OpenSAFELY report..

The code and data for this report can be found at the OpenSafely antibody-and-antiviral-deployment repository.

Introduction

Methods

Results

Overall coverage of COVID-19 treatment

Between 11-Dec-2021 and 23-Feb-2022, a total of 50,730 non-hospitalised patients registered at a TPP practice in England were identified as being eligible for receiving an antiviral or nMABs for treating COVID-19 (Figure 1). While the majority of these patients only belonged to one high risk cohort, 7,690 (15%) eligible patients had records indicating that they fell into multiple high risk cohorts (high risk cohort count range 1 - 6). Out of the 50,730 eligible patients, a total of 6,460 patients received an antiviral or nMABs (Figures 2 and 3);

  • Paxlovid: 110;
  • Sotrovimab: 3,610;
  • Remdesivir: 0;
  • Molnupiravir: 2,680;
  • Casirivimab: 50.
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Figure 1: Cumulative total of patients eligible for receiving an antiviral or nMABs for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Patients are included as eligible on the date of thier positive SARS-CoV-2 test. Note, eligible patients can appear in more than one high risk group and the overall number (pre 10th February 2022) in each group is likely to be an overestimation due to including patients where their SARS-CoV-2 infection is confirmed by a lateral flow or polymerase chain reaction test.

Figure 1: Cumulative total of patients eligible for receiving an antiviral or nMABs for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Patients are included as eligible on the date of thier positive SARS-CoV-2 test. Note, eligible patients can appear in more than one high risk group and the overall number (pre 10th February 2022) in each group is likely to be an overestimation due to including patients where their SARS-CoV-2 infection is confirmed by a lateral flow or polymerase chain reaction test.

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Figure 2: Cumulative total of patients who received an antiviral or nMAB for treating COVID-19 since 11th December 2021, stratified by treatment type

Figure 2: Cumulative total of patients who received an antiviral or nMAB for treating COVID-19 since 11th December 2021, stratified by treatment type

Coverage of COVID-19 treatment by high risk cohort

Figure 3: Cumulative total of patients who received an antiviral or nMABs for treating COVID-19 since 11th December 2021, stratified by high risk cohorts. Note, treated patients can appear in more than one high risk group.

Figure 3: Cumulative total of patients who received an antiviral or nMABs for treating COVID-19 since 11th December 2021, stratified by high risk cohorts. Note, treated patients can appear in more than one high risk group.

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Figure 4: Weekly proportion of eligible patients receiving an antiviral or nMAB for treating COVID-19 since 11th December 2021, stratified by high risk cohort

Figure 4: Weekly proportion of eligible patients receiving an antiviral or nMAB for treating COVID-19 since 11th December 2021, stratified by high risk cohort

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Table 1: Proportion of eligible patients who have recieved treatment for COVID-19 since 11th December 2021, broken down by high risk cohort and treatment type
Treated
Eligible
All
Paxlovid
Sotrovimab
Remdesivir
Molnupiravir
Casirivimab
High risk cohort Count Count % Count (%) Count (%) Count (%) Count (%) Count (%)
All 50730 6420 13 80 (1) 3600 (56) <5 2680 (42) 50 (1)
Immune-mediated inflammatory disorders 20390 3030 15 30 (1) 1720 (57) <5 1250 (41) 20 (1)
Primary immune deficiencies 9940 1190 12 20 (2) 620 (52) <5 540 (45) 10 (1)
Solid cancer 8370 950 11 10 (1) 550 (58) <5 380 (40) 10 (1)
Rare neurological conditions 5680 920 16 20 (2) 480 (52) <5 420 (46) 10 (1)
Haematological diseases and stem cell transplant recipients 4530 930 21 10 (1) 520 (56) <5 390 (42) 10 (1)
Solid organ transplant recipients 3490 860 25 <5 560 (65) <5 290 (34) 10 (1)
Renal disease 3160 800 25 <5 540 (68) <5 260 (32) 10 (1)
Liver disease 3130 320 10 <5 170 (53) <5 140 (44) <5
Down’s syndrome 1090 150 14 <5 50 (33) <5 100 (67) <5
Immuosupression due to HIV or AIDS (CD4 <350 cells/mm3) 330 190 58 <5 70 (37) <5 120 (63) <5

Key demographic and clinical characteristics of treated patients

Table 2: Count and proportion of eligible patients who have received treatment for COVID-19, broken down by demographic and clinical categories and by and treatment type
Treated
Eligible
All
Paxlovid
Sotrovimab
Remdesivir
Molnupiravir
Casirivimab
Group Variable Count Count % Count (%) Count (%) Count (%) Count (%) Count (%)
Age band 12-29 5050 550 11 10 (2) 300 (55) <5 230 (42) 10 (2)
Age band 30-39 6470 990 15 10 (1) 570 (58) <5 390 (39) 10 (1)
Age band 40-49 8390 1320 16 20 (2) 750 (57) <5 530 (40) 10 (1)
Age band 50-59 10050 1450 14 40 (3) 820 (57) <5 580 (40) 10 (1)
Age band 60-69 8740 1130 13 20 (2) 640 (57) <5 460 (41) 10 (1)
Age band 70-79 7330 760 10 10 (1) 410 (54) <5 340 (45) <5
Age band 80+ 4700 270 6 <5 110 (41) <5 150 (56) <5
Sex Female 28640 3810 13 70 (2) 2170 (57) <5 1550 (41) 20 (1)
Sex Male 22090 2650 12 40 (2) 1440 (54) <5 1130 (43) 30 (1)
Sex Unknown
<5 <5 <5 <5 <5
Ethnicity White 40570 5480 14 100 (2) 3090 (56) <5 2240 (41) 40 (1)
Ethnicity Asian or Asian British 2540 330 13 <5 210 (64) <5 120 (36) <5
Ethnicity Black or Black British 2030 190 9 <5 100 (53) <5 80 (42) <5
Ethnicity Mixed 670 80 12 <5 40 (50) <5 40 (50) <5
Ethnicity Other ethnic groups 830 90 11 <5 40 (44) <5 50 (56) <5
Ethnicity Unknown 4090 290 7 10 (3) 130 (45) <5 150 (52) <5
IMD 1 most deprived 10310 920 9 20 (2) 530 (58) <5 370 (40) 10 (1)
IMD 2 10000 1180 12 20 (2) 650 (55) <5 500 (42) 10 (1)
IMD 3 10340 1450 14 20 (1) 800 (55) <5 610 (42) 10 (1)
IMD 4 9720 1350 14 20 (1) 770 (57) <5 550 (41) 10 (1)
IMD 5 least deprived 8970 1380 15 30 (2) 760 (55) <5 580 (42) 10 (1)
IMD Unknown 1400 180 13 <5 100 (56) <5 80 (44) <5
Rurality Urban - conurbation 13660 1370 10 20 (1) 770 (56) <5 580 (42) <5
Rurality Urban - city and town 26040 3470 13 70 (2) 1840 (53) <5 1520 (44) 30 (1)
Rurality Rural - town and fringe 5900 850 14 10 (1) 520 (61) <5 310 (36) 10 (1)
Rurality Rural - village and dispersed 3790 590 16 10 (2) 380 (64) <5 200 (34) 0 (0)
Rurality Unknown 1350 180 13 <5 100 (56) <5 80 (44) <5
Region East Midlands 9050 1060 12 20 (2) 740 (70) <5 280 (26) 20 (2)
Region East of England 12000 2040 17 10 (0) 1110 (54) <5 890 (44) 20 (1)
Region London 3210 420 13 10 (2) 160 (38) <5 250 (60) <5
Region North East 2730 320 12 <5 240 (75) <5 80 (25) <5
Region North West 5340 610 11 20 (3) 300 (49) <5 290 (48) <5
Region South East 3240 430 13 10 (2) 240 (56) <5 180 (42) <5
Region South West 5880 940 16 30 (3) 440 (47) <5 460 (49) <5
Region West Midlands 2080 250 12 <5 200 (80) <5 50 (20) <5
Region Yorkshire and the Humber 7140 400 6 10 (2) 180 (45) <5 210 (52) <5
Region Unknown 70 10 14 <5 0 (0) <5 <5 <5
Autism Autism 300 40 13 <5 20 (50) <5 30 (75) <5
Care home Care home 1700 60 4 <5 10 (17) <5 50 (83) <5
Dementia Dementia 1230 50 4 <5 10 (20) <5 30 (60) <5
Learning disability Learning disability 1310 170 13 0 (0) 60 (35) <5 100 (59) <5
Serious mental illness Serious mental illness 700 70 10 <5 30 (43) <5 30 (43) <5
Housebound Housebound 1830 180 10 <5 90 (50) <5 80 (44) <5
CEV CEV 26850 4570 17 70 (2) 2600 (57) <5 1860 (41) 40 (1)
Sickle cell disease Sickle cell disease 750 50 7 <5 20 (40) <5 20 (40) <5
Vaccination status Un-vaccinated (declined) 790 30 4 <5 20 (67) <5 10 (33) <5
Vaccination status Un-vaccinated 2310 120 5 <5 60 (50) <5 60 (50) <5
Vaccination status One vaccination 1580 130 8 <5 70 (54) <5 50 (38) <5
Vaccination status Two vaccinations 7330 520 7 10 (2) 280 (54) <5 220 (42) 10 (2)
Vaccination status Three or more vaccinations 38720 5660 15 100 (2) 3190 (56) <5 2340 (41) 40 (1)

Concordance with guidance

Of the 6460 patients who received treatment for COVID-19 between 11-Dec-2021 and 23-Feb-2022, 1,255 patients were missing records needed to confirm eligibility. It is likely that most, if not all, of these patients meet all of the eligibility criteria and non of the exclusion criteria but, for example, their SARS-CoV-2 test result was not available in their record or we just do not have access to all the criteria the clinician might use to assess high risk group status (such as the patients identified via non digital methods).

Figure 4: Breakdown of eligibility criteria variables in treated patients with missing records needed to confirm eligibility

Figure 4: Breakdown of eligibility criteria variables in treated patients with missing records needed to confirm eligibility

Time to treatment

Figure 4a: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by treatment type

Figure 4a: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by treatment type

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Figure 4b: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by high risk cohort

Figure 4b: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by high risk cohort